Journal of Clinical Oncology, Vol 21, Issue 22
(November), 2003: 4184-4193
© 2003 American Society for Clinical Oncology
Breast Cancer in Younger Women: Reproductive and Late Health Effects of Treatment
Patricia A. Ganz,
Gail A. Greendale,
Laura Petersen,
Barbara Kahn,
Julienne E. Bower
From the University of California Los Angeles (UCLA) Schools of Medicine and Public Health; Division of Cancer Prevention & Control Research, Jonsson Comprehensive Cancer Center at UCLA; Division of Geriatrics, Department of Medicine, and Department of Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine at UCLA; Cousins Center for Psychoneurimmunology, UCLA Neuropsychiatric Institute, Los Angeles, CA.
Address reprint requests to Patricia A. Ganz, MD, Division of Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900; e-mail: pganz{at}ucla.edu.
Purpose: In 1997, we initiated a cohort study to evaluate quality of life (QOL) and reproductive health outcomes in younger female breast cancer survivors.
Materials and Methods: Using listings from two tumor registries, we recruited women with stage 0, I, or II breast cancer who were 50 years or younger at diagnosis and were also disease-free survivors for 2 to 10 years. A mailed survey questionnaire assessed medical and demographic factors, health-related QOL, mood, outlook on life, and reproductive health outcomes.
Results: We recruited 577 women, who ranged in age from 30 to 61.6 years (mean, 49.5 years) and were surveyed approximately 6 years after diagnosis. Almost three fourths had received some form of adjuvant therapy. Amenorrhea occurred frequently as a result of treatment in women  40 years at diagnosis, and treatment-associated menopause was associated with poorer health perceptions. Across the cohort, physical functioning was quite good, but the youngest women experienced poorer mental health (P = .0002) and less vitality (energy; P = .03). Multiple regression analyses predicting QOL demonstrated better outcomes in African-American women, married or partnered women, and women with better emotional and physical functioning, whereas women who reported greater vulnerability had poorer QOL.
Conclusion: Overall QOL in younger women who survive breast cancer is good, but there is evidence of increased emotional disruption, especially among the youngest women. Factors that may contribute to poorer health perceptions and QOL include experiencing a menopausal transition as part of therapy, and feeling more vulnerable after cancer.
Supported by funding from the National Cancer Institute (P30 CA16042), the Susan G. Komen Foundation, and the US Department of Defense (DAMD 17-98-1-1810). P.A.G. was also supported through an American Cancer Society Clinical Research Professorship.
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